July 26, 2013
EDUCATIONAL AND TRAINING REQUIREMENTS FOR LICENSURE OF PHYSICIANS AND NURSES
By: Nicole Dube, Principal Analyst
You asked for information on the educational and training requirements for licensure of physicians, registered nurses, and advanced practice registered nurses.
Physicians, registered nurses (RNs), and advanced practice registered nurses (APRNs) must be licensed by the Department of Public Health (DPH) in order to practice in Connecticut. Generally, an applicant seeking licensure must successfully complete educational and training requirements, as well as pass an examination.
No person can practice medicine or surgery in Connecticut without a DPH license (CGS § 20-9). The licensure requirements differ somewhat depending on whether the applicant is educated and trained in the United States or another country.
United States-Trained Applicants
A U.S.-trained applicant for physician licensure must have:
1. graduated with an M.D. or D.O. (Doctor of Osteopathy) degree from a medical school accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA);
2. completed at least two years of progressive, post-graduate medical training as a resident physician in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the AOA; and
3. successfully completed one of the examinations listed in Table 1.
Table 1: Required Physician Licensure Examinations
Examinations (Applicants must complete one examination from this list)
● A state board licensing examination completed before June 1, 1979
● United States Medical Licensing Examination (USMLE)
● National Board of Medical Examiners (NBME)
● Federation Licensing Examination (FLEX)
● National Board of Osteopathic Medical Examiners (NBOME)
● The examination required to become registered as a Licentiate of the Medical Council of Canada (LMCC)
● A combination of (1) NBME Part I or USMLE Step 1, (2) NBME Part II or USMLE Step 2, and (3) NBME Part II or USMLE Step 3
● A combination of FLEX Component 1 and USMLE Step 3
● A combination of (1) NBME Part I or USMLE Step 1, (2) NBME Part II or USMLE Step 2, and (3) FLEX Component 2
*Source: CGS § 20-10; Conn. Agencies Regs., §§. 20-10-1 et seq.
DPH's physician licensure application can be found at: http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/physician/md_app_only.pdf
Graduates of Foreign Medical Schools
A physician license applicant graduating from a medical school located outside the U.S., its territories, or Canada must be a graduate of a school listed in the 1970 World Health Organization Directory of Medical Schools, or demonstrate successful completion of an educational program satisfying all DPH regulatory requirements. Applicants who earned a D.O. degree in a country other than the U.S. or Canada are not eligible for licensure.
Graduates of foreign medical schools must also:
1. hold current certification by the Educational Commission on Foreign Medical Graduates (ECFMG) or have completed an American Medical Association (AMA)-certified Fifth Pathways Program;
2. complete at least two years of progressive, post-graduate medical training as a resident physician in a program accredited by the ACGME or its equivalent; and
3. successfully complete one of the following examinations: USMLE, NBME, FLEX, NBOME, LMCC, or an acceptable combination of examinations listed in Table 1.
All physician licensure applicants must submit the following:
1. a completed, notarized application with photo and fee of $565 and a separate bank check or money order of $4.75 to cover DPH's cost for querying the National Practitioner Data Bank;
2. an official transcript of medical education verifying the applicant's M.D. or D.O. degree forwarded directly to DPH from the educational institution;
3. for foreign-trained applicants, verification of current certification by ECFMG or successful completion of an AMA- certified Fifth Program;
4. verification of completion of at least two years of progressive, post-graduate residency training submitted directly from the chief of staff/program director of the residency program;
5. an official transcript of examination scores forwarded directly to DPH from the examination entity; and
6. verification of any other state licenses held, current or expired, submitted directly to DPH from the source.
REGISTERED NURSES (RN)
RNs (1) provide supportive and restorative care, health counseling and teaching, and case finding and referral; (2) collaborate in implementing a patient's total health care regimen; and (3) execute medical care under the direction of a licensed physician, dentist, or APRN. RNs can also execute orders by licensed PAs, podiatrists, and optometrists, as long as doing so doesn't exceed the scope of practice of the nurse or ordering practitioner (CGS § 20-87a).
An individual is eligible for RN licensure if he or she holds a degree, diploma, or certificate from an accredited nursing program approved by the Connecticut State Board of Examiners for Nursing with DPH's consent (CGS § 20-93). The program's nursing component must be equivalent to four 15-week academic semesters and contain a minimum of 35 credits in nursing. Fifty percent of contact hours must be in direct client care experiences, observational experiences, simulated experiences, and lab experiences (Conn. Agencies Regs. § 20-90-52).
Applicants must also successfully complete the National Council of State Boards of Nursing Licensing Examination-RN (NCLEX-RN) exam and submit the following documents directly to DPH:
1. a completed application form with a $180 fee;
2. an official transcript, sent directly from the nursing school, verifying the award of a diploma, certificate, or degree in nursing; and
3. for foreign-trained applicants, verification of completion of the International Certification Program, sent directly to DPH from the CGFNS International Credential Evaluation Service.
DPH's RN licensure application can be found at: http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/nursing/rn/rn_app_only.pdf.
ADVANCED PRACTICE REGISTERED NURSES (APRN)
APRNs are recognized in statute as primary care providers and can hold hospital privileges. They perform advanced levels of nursing, including diagnosing and treating patients and prescribing medications. State law requires APRNs to perform these functions in collaboration with a licensed physician. Written documentation of this collaboration is required only for an APRN to prescribe medication. Among other things, this written agreement must specify which Schedule II and Schedule III controlled substances (e.g., drugs such as morphine, oxycodone, and anabolic steroids) the APRN can prescribe. A licensed APRN maintaining current certification from the American Association of Nurse Anesthetists, who is prescribing and administering medical therapeutics during surgery, may only do so if the physician who is medically directing the prescriptive activity is physically present in the setting where the surgery is taking place (CGS § 20-87a(b)). (For more information on APRN collaborative agreements, see OLR Report 2012-R-0518.)
To obtain an APRN license, an applicant must:
1. hold a current Connecticut RN license;
2. hold and maintain current certification as a nurse practitioner, clinical nurse specialist, or nurse anesthetist from one of the national certifying organizations listed in Table 2;
3. complete 30 hours of pharmacology education for advanced practice nursing; and
4. if first certified by one of the national bodies listed in Table 2 after December 31, 1994, hold a master's degree in nursing or a related field recognized for certification as either a nurse practitioner, clinical nurse specialist, or nurse anesthetist by one of the bodies below (CGS § 20-94a(a)).
Table 2: National Certifying Organizations for Nursing Specialties
● American Nurses' Association
● National Certification Board of Pediatric Nurse Practitioners and Nurses
● National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
● American Association of Nurse Anesthetists
● American Academy of Nurse Practitioners
● Oncology Nursing Certificate Corporation
● the American Association of Critical-Care Nurses
*Source: DPH website, http://www.ct.gov/dph/cwp/view.asp?a=3121&q=389400&dphNav_GID=1821
Applicants must also submit the following documents directly to DPH:
1. a completed application form with a photograph and $200 fee;
2. an official verification of current certification by one of the above national certifying organizations;
3. official verification of at least 30 hours of pharmacology instruction for advanced nursing practice, sent directly by the institution to DPH;
4. an official transcript, sent directly from the nursing school, verifying post basic nursing education; and
5. verification of all licenses held, current or expired, from each state the applicant is or was licensed as an APRN, RN, or licensed practical nurse.
DPH's APRN licensure application can be found at: http://www.ct.gov/dph/LIB/dph/practitioner_licensing_and_investigations/plis/nursing/aprn/APRN_APP_Only.pdf.